Electrocardiography changes in patients with acute myocardial infarction in late hospital phase

One of possibilities to estimate size of myocardial injury during the acute myocardial infarction are electrocardiographic changes, forming of QS formation (ECG signs of scares changes). This investigation which included three groups of patients receiving thrombolytic, nitrates or beta blockers in acute phase of myocardial infarction has aim to analyze 12-chanels electrocardiogram and to establish difference between this therapeutics groups in sum of QRS score, but also to indication frequency of periinfarction heart insufficiency in this therapeutics groups, comparing with observed ECG changes. Analysis shows significant differences between groups in value of QRS score, and also significant lower value of QRS score in patients with acute myocardial infarction treated with thrombolytic therapy. This difference relative to other two groups shows lower level of myocardial injury during acute myocardial infarction in patients treating with thrombolytic therapy

Abnormally high values of cardiac troponin i in hypertrophic cardiomyopathy and diastolic heart failure

This paper presents a 73-year old woman who was hospitalized in the Intensive care unit because of shortness of breath and atypical chest discomfort two hours ago. Blood pressure on admission was very high (240/130 mmHg), cardiac troponin I was above the reference value (2,1 ng/ml) and initial ECG recording was suggestibile for myocardial infarction without ST elevation. Echocardiographic evaluation and coronary arteriography that followed rule out acute coronary syndrome as a cause of increased cardiac troponin

Clinical, diagnostic and therapeutic aspects of pulmonary embolism

Pulmonary embolism (PE) and venous thromboembolism are two clinical manifestations of a single entity - venous thromboembolism. PE usually occurs through due thrombi from the lower veins, and in 10-15% of cases are due thrombus from upper veins or right heart failure. Significance is mainly determined by the frequency (1/1000 per year in the adult population; less in younger but significant increase with increasing age), the risk of mortality is important in acute and chronic diseases that are associated with this clinical manifestation. Acute pulmonary embolism is often fatal, with a mean annual mortality of about 30% in untreated. Many deaths occur because of recurrent PE within the first few hours after the initial event. In the nineteenth century, Virchow the mechanism of thromboembolism categorized into three groups: changes in the blood vessel wall, a reduction of blood flow (path) and changes in the composition of the blood (hypercoagulable, prothrombotic). Modern interpretation of the pathogenesis of thromboembolism, which is processed corresponds Virhovljevom concept. In general thromboembolic events can be a result of complications of individual risk factors as increased thrombotic potential

Predictors of improved quality of life six months after coronary artery bypass surgery

Predictors of improved quality of life after coronary artery bypass surgery (CABG) are still incompletely known. To determine the predictors of improving the quality of life six months after coronary artery bypass surgery. We studied 208 consecutive patients, who underwent elective CABG. The Nottingham Health Profile Questionnaire part 1 was used as the model for quality of life determination. Questionnaire contains 38 subjective statements divided into six sections: physical mobility, social isolation, emotional reaction, energy, pain and sleep. We distributed the questionnaire to all patients before CABG and six months after CABG. The mean age of patients was 58,8 ± 8,2 years, 82% were males. The comparison between mean preoperative and postoperative scores showed that improvement was found in 53.7% of patients, worsening in 12.5%, quality of life before and after the intervention was normal in 26.7%, and no changes in quality of life was at 7.08%. Independent predictors of patients improvement by CABG were as follows: absence of previous myocardial infarction in the physical mobility section (p=0.03; OR=0.59; CI 0.40-0.92), higher CCS angina class in the physical mobility (p=0.006; OR=2.34; CI 1.46-3.32), energy (p=0.02; OR=1.70; CI 1.29-2.64) and pain sections (p<0.001; OR=4,64; CI 2.27-7.31), mail gender in the pain section (p=0.03; OR=0.45; CI 0.26-0.62) and younger age in the pain section (p=0.01; OR=0.69; CI 0.41-0.85). The predictive factors for quality of life improvement six months after CABG are higher CCS angina class, absence of previous myocardial infarction, mail gender and younger age

Global overview of the management of acute cholecystitis during the COVID-19 pandemic (CHOLECOVID study)

Background: This study provides a global overview of the management of patients with acute cholecystitis during the initial phase of the COVID-19 pandemic. Methods: CHOLECOVID is an international, multicentre, observational comparative study of patients admitted to hospital with acute cholecystitis during the COVID-19 pandemic. Data on management were collected for a 2-month study interval coincident with the WHO declaration of the SARS-CoV-2 pandemic and compared with an equivalent pre-pandemic time interval. Mediation analysis examined the influence of SARS-COV-2 infection on 30-day mortality. Results: This study collected data on 9783 patients with acute cholecystitis admitted to 247 hospitals across the world. The pandemic was associated with reduced availability of surgical workforce and operating facilities globally, a significant shift to worse severity of disease, and increased use of conservative management. There was a reduction (both absolute and proportionate) in the number of patients undergoing cholecystectomy from 3095 patients (56.2 per cent) pre-pandemic to 1998 patients (46.2 per cent) during the pandemic but there was no difference in 30-day all-cause mortality after cholecystectomy comparing the pre-pandemic interval with the pandemic (13 patients (0.4 per cent) pre-pandemic to 13 patients (0.6 per cent) pandemic; P = 0.355). In mediation analysis, an admission with acute cholecystitis during the pandemic was associated with a non-significant increased risk of death (OR 1.29, 95 per cent c.i. 0.93 to 1.79, P = 0.121). Conclusion: CHOLECOVID provides a unique overview of the treatment of patients with cholecystitis across the globe during the first months of the SARS-CoV-2 pandemic. The study highlights the need for system resilience in retention of elective surgical activity. Cholecystectomy was associated with a low risk of mortality and deferral of treatment results in an increase in avoidable morbidity that represents the non-COVID cost of this pandemic